Provider Demographics
NPI:1053657049
Name:BRIDGET REILLY SHEAHAN DDS PLLC
Entity Type:Organization
Organization Name:BRIDGET REILLY SHEAHAN DDS PLLC
Other - Org Name:DENTAL CLINIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:REILLY
Authorized Official - Last Name:SHEAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-536-8888
Mailing Address - Street 1:3144 E 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-4848
Mailing Address - Country:US
Mailing Address - Phone:509-536-8888
Mailing Address - Fax:509-536-8894
Practice Address - Street 1:3144 E 29TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-4848
Practice Address - Country:US
Practice Address - Phone:509-536-8888
Practice Address - Fax:509-536-8894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00010579122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty